Cervical Spine Lecture Flashcards
What are the two causes of neck pain?
Traumatic or Atraumatic
If neck pain is traumatic, what are the possible causes?
Myofascial injury, cervical fractures, cord or nerve root injury, SCIWORA
What is your first step if you suspect cervical fractures?
1) Image 2) Neurosurgical consultation 3) Document EVERYTHING (sensory and motor loss, AND rectal tone)
What is SCIWORA?
spinal cord injury wihtout radiographic abnormality (MUST keep spine immobilized until MRI)
What does NEXUS criteria determine?
1) Does the patient need imaging (if does not met criteria, does not need imagine)
What is the NEXUS criteria?
- Absence of posterior midline cervical tenderness
- Normal level of alterness
- No evidence of intoxication
- No abnormal neurologic findings
- No painful distracting injuries
if any of these are NO, place in collar and image
(NEXUS: No posterior midline tenderness Everything ok? (level of alterness) X amount of drinks U can feel this right? Super hurt -- other injuries
Causes of atraumatic neck pain
1) MSK: most likely cervical spondylosis (degenerative changes)
2) Neurological: radiculopathy and/or myelopathy
3) Nonspinal causes
What are some nonspinal causes?
Coronary artery disease (cardiac issues, MI). malignancy (lymph nodes in neck), tension headaches, rheumatological conditions, thoracic outlet
myelopathy (cause, Symptoms, trtmnt)
deficit related to SPINAL CORD
Sx: bilateral or distal sx (weakness, numbness) complain of clumsy hands, gait disturbances, sexual dysfunction, bowel or bladder dys (relatively sudden onset)
Trt: EMERGENT MRI
radiculopathy (cause, sympt, trtmnt)
deficit related to NERVE ROOT
Sx: sharp, burning pain, radiates into arms (numbness, ringling)
MOST COMMON: C5-C6, C6-C7
Trt: urgent workup, non-emergent MRI, NSAIDS, OMM, PT
Spondylosis
Most common cause of acute chronic neck pain
degenerative discs and osteophytes (narrowing, roughness between vert)
Meningitis (cause, sympt, trtmnt)
Cause: bacterial, N. Menigitidis (gram neg), viral (herpes)
Sx: fever, neck stiffness + something else (malaise, headache) (if N. Menigitidis, have rash)
TEST: Nuchal rigidity, Kernig’s, Brudzinski’s, lumbar pucnture
Trt: Broad spectrum antiboditics, dependent on etiology
Thoracic Outlet syndrome (Sx, Test)
compression of neurovas bundle above first rib and behind clavicle
Sx: arm pain, numbness, weakness (Ex: painter who holds his arm up over his head has numbness and tingling)
Test: Roo’s EAST, Adsons
What is Roo’s / EAST Test
abducts shoulder to 90 deg and externally rotates (touchdown symbol) open and close first for 3 minutes
POSITIVE: Pain/paraesthesia
Specifically compression of subclavian artery
What do you want to do if your patient has atraumatic neck pain with progressive neurologic findings? worse with sleep? last more than 6 weeks?
IMAGE THEM
